A community-wide approach to behavioral health crisis management

The Mental Health Emergency Room Extension (MHERE) serves patients in acute psychiatric distress and ensures public safety by providing rapid assessment, observation, stabilization and treatment initiation. These patients are either a danger to themselves, others or gravely disabled. The MHERE is a crisis continuum component that assists law enforcement, hospital emergency departments, jails, and public and private sector budgets. The goals of the MHERE are rapid stabilization and disposition to an appropriate level of care and establishing connections for ongoing care to avoid readmissions and cycles of crises. Within two years of operating 10 beds, it served more than 3,400 patients and saved the state over $20.6M, by avoiding hospitalizations for 68% of the patients admitted. Its operational linkage to community-based public behavioral health clinics and the use of a mobile treatment component increased show rates for post-discharge clinic appointments from 32% to 79.6% in a six month period. The mobile team provided face to-face and telephonic outreach to increase appointment show rates. Demand for units of this type is growing due to deinstitutionalization, increasing substance abuse, and our warriors returning from active combat and their family members. A specialized crisis center addresses serious personal and public safety consequences of behavioral health crises and decreases the strain on local emergency departments which otherwise board these patients until they are stabilized, transferred at a higher rate to costly, acute psychiatric hospital beds, or discharged, often to an environment that cannot provide them ongoing support needed to prevent a cycle of crises.